DONATION FORM
COMPANY NAME: ______________________________________________________
ADDRESS: _____________________________________________________________
CITY: ________________________ STATE: _________________ ZIP: ___________
TELEPHONE: __________________________
FAX: ___________________________
AMOUNT OF DONATION
(circle donation amount):
$100
$200 $300 $400 $500
$1000
OTHER: $_____________________
RECEIPTIENT (please
circle charity of your choice):
AMERICAN RED CROSS UNITED
WAY NYC RESCUE
MISSION SALVATION ARMY
CATHOLIC CHARITIES
H.E.L.P. N.E.R.T.
FEDERATION OF ORGANIZATIONS
PHOENIX HOUSE W.I.N. OPTIONS
FOR COMMUNITY LIVING
PRODJECT REDIRECT
SAFE HORIZON VICTIM SVCS HOPE CHEST VOLUNTEERS OF AMERICA
FEDERATION OF PROTESTANT WELFARE AGENCIES
OTHER:__________________________________________________________
______ ALLOW START-RITE, INC. CHOOSE
THE CHARITY
PAYMENT METHOD:
_____ CORPORATE CHECK
_____ CREDIT CARD
MASTERCARD VISA
AMERICAN EXPRESS DISCOVER
ACCT.#_________________________________________________________________
EXPERATION DATE:___________
AUTHORIZATION :___________________________________________
